Surabaya Physical Medicine and Rehabilitation Journal. February 2020. Vol: 2. Ed: 1.

Original Research

Association between Muscle Mass and Muscle Strength with

Physical Performance in Elderly in Surabaya
Titin Kristiana1, Novira Widajanti1, Rwahita Satyawati2
1
Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga/ Dr. Soetomo General
Hospital –Indonesia
2
Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Airlangga/
Dr. Soetomo General Hospital –Indonesia

Corresponding Author:
Novira Widajanti, dr., Sp.PD, KGER, Department of Internal Medicine, Faculty of Medicine, Airlangga University/Dr.
Soetomo General Hospital–Indonesia Mayjend Prof. Dr. Moestopo Str. No. 47, Surabaya, Jawa Timur, 60131, Indonesia
Phone: - / Email: novirawijanti@yahoo.com

ABSTRACT
Background: Sarcopenia is a decrease in muscle mass and strength that mostly happens in the elderly.
Sarcopenia is a problem that is often found in the elderly who are at risk of disability, hospitalization and
death. This data on muscle mass and strength with physical performance is expected to support the theory
of sarcopenia and as a reference in promoting and preventing sarcopenia in elderly.
Aims: To analyze the association between muscle mass and strength (handgrip strength) with physical
performance assessed using Short Physical Performance Battery (SPPB) in an elderly community.
Methods: This study was a cross-sectional observational analytic study involving 203 sample of elderly
(age >60 years old). The subjects were categorized as the strong and weak muscle mass and muscle
strength, also the high, moderate and low physical performance. We used Bioimpedance Analysis (BIA)
and hand dynamometer to measure muscle mass and muscle strength (handgrip strength). SPPB was used to
assess physical performance.The association between muscle mass and strength with physical performance
was displayed in bivariate analysis with chi square.
Result: Of all 203 subjects, 57 were males and 146 were females. Chi square test showed association
between muscle strength (handgrip strength) with physical performance (SPPB) (p=0.001), with a weak
correlation (r=0.26) and no association between muscle mass and physical performance (SPPB) (p=0.517).
Conclusion: There is a positive association between muscle strength with physical performance, with a
weak correlation and no association between muscle mass and physical performance in the elderly
community in Surabaya.

Keywords: Muscle mass, muscle strength, handgrip strength, physical performance, elderly

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 Surabaya Physical Medicine and Rehabilitation Journal. February 2020. Vol: 2. Ed: 1.
Introduction
Sarcopenia is a decrease in muscle mass
and strength that mostly happens in the elderly.
Sarcopenia is a problem that is often found in
the elderly who are at risk of disability,
hospitalization, and death. The Asian Working
Group for Sarcopenia (AWGS) in 2014 stated
that the Asian population has the highest
prevalence for low muscle mass, low strength,
and low physical performance compared to non
Asian, ranging from 4.1% to 11.5%1
Limpawattana et al.(2015) in Thailand showed
a low muscle mass prevalence in Asia 22.1%
for males and 21.8% for females. 2 Physical
performance is an important thing in physical
function which impacts the mobility,
independency, and quality of life in elderly.
Sarcopenia decreases the physical performance
and eventually leads to worse outcome.
Physical performance is affected by
muscle mass and strength. Factors influencing
muscle mass and strength are the following:
age, sex, ethnicity, weight, Body Mass Index
(BMI), cardiac disease, dyslipidemia, low
protein and vitamin D intake, and low physical
activity.1Other factor contributing to the
decrease in muscle strength is the decrease of
motor unit, causing muscle fiber atrophy. 3 The
cross-sectional study by Kim et al., 2012 in
Korea showed that muscle mass is not
correlated with physical performance assessed
using Short Physical Performance Battery
(SPPB) in frail elderly.4 However, cohort study
by Hughles et al., 2001 in England showed after
follow-up of 12 years there was a significant
change in quadriceps muscle with loss in
extension strength of the knee in elderly males.
Furthermore, a cohort prospective study by
Kim et al., 2016 in Korea showed that muscle
strength (handgrip strength) is a better indicator
than muscle mass to physical performance
assessed with SPPB in elderly.5 The cohort
prospective study by Legrand et al., 2013 in
Belgium showed an association between
muscle strength (handgrip strength) with
physical performance assessed using SPPB in
elderly in a community.6 The data of muscle
mass and strength (handgrip strength) with
physical performance assessed using SPPB in
elderly in Indonesia is still lacking.
In elderly there is a faster decrease in
muscle strength than muscle mass. If the
decrease in fast-type muscle fibers greater than
in slow-type muscle fibers, it will strongly
affects the muscle strength. The mitochondria
change happening in subcellular level causes a
decrease in muscle function in the elderly. 3 The
European Working Group on Sarcopenia in
Older People (EWGSOP) in 2010
recommended several tests to assess physical
performance: walking speed, 6-minutes
walking test, stair-climbing test, timed-up-and-
go test (TUG) and Short Physical Performance
Battery (SPPB).7,8 Short Physical Performance
Battery consists of balance test also walking
speed, strength and endurance assessment by
assessing individual’s ability to stand in side-
by-side feet position, semi-tandem, and tandem
position, the time to walk for 8 feet and time to
stand from a chair and back to sitting for 5
times. Physical Performance Battery (SPPB) is
an appropriate, easy, reliable, practically usable
test and represents all other physical
performance tests.7 The muscle mass
assessment is done using Bioimpedance
Analysis (BIA), this device is easy to carry,
cost-effective, with easy and fast preparation,
non-invasive, radiation-free, and comfortable to
be used to assess sarcopenia in community.9
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 Surabaya Physical Medicine and Rehabilitation Journal. February 2020. Vol: 2. Ed: 1.
Handgrip strength is assessed using hand
dynamometer, which has a good and safe
results, also with a reasonable price and easy to
get and use.10 This corresponds to the study to
test a device’s validity to measure muscle mass,
strength and physical performance by
Mijnarends et al., 2013 in the Netherlands, who
stated that measurement of muscle mass using
Bioimpedance Analysis (BIA) device, muscle
strength (handgrip strength) using
dynamometer and physical performance using
Short Physical Performance Battery (SPPB) is
an appropriate, easy and reliable assessment. 11
Several studies in Asia and Europe
showed various results however there is no
study has ever been done on the association
between muscle mass and strength (handgrip
strength) and physical performance assessed
using Short Physical Performance Battery
(SPPB) in Surabaya, therefore in this study we
aim to assess the association between muscle
mass and strength (handgrip strength) with
physical performance assessed using Short
Physical Performance Battery (SPPB) in the
elderly community. This study is also a part of
a study in sarcopenia and frailty profile in
elderly community in Surabaya.
The general aim of this study is to
analyze the association between muscle mass
and strength (handgrip strength) with physical
performance assessed using Short Physical
Performance Battery (SPPB) in the elderly
community in Surabaya. The results of this
study can be used as a reference in promotive
and preventive healthcare in the elderly
community.
Material and Methods
This study was a cross-sectional
observational analytic study. Samples included
in this study were elderly of age >60 years old,
registered in five PosyanduLanjutUsia(Elderly
integrated health
service)Puskesmas(Community Health Center)
Surabaya consist ofPuskesmasMenur,
PuskesmasSememi, PuskesmasPutat Jaya,
Puskesmas Perak
TimurandPuskesmasTambakRejowho met the
inclusion and exclusion criteria.
Inclusion criteria in this study were
people of age > 60 years old, willing to
participate in this study and sign the informed
consent. Exclusion criteria were limitations of
mobilization (ADL <8, has difficulty to walk
independently with/without assistive devices,
arthritis, recent fracture), difficulty
understanding the assessment instructions
(MMSE<18), and unable to undergo
examination (NYHA 3 and 4,
RR>20x/minutes).
The subjects who met inclusion and
exclusion criteria were examined sequentially:
muscle mass, muscle strength (handgrip
strength), and physical performance (SPPB)
which conducted 10 minutes after examination
of muscle strength (handgrip strength). The
results were then tabulated and analyzed.
All data were analyzed using SPSS
version 20 software. Bivariate analysis was
performed using chi square test to determine
the association between one variable with
another. Multivariate analysis was performed
on variables with bivariate analysis with p<0.25
to determine the association/influence of
several independent variables with a dependent
variable simultaneously. Multivariate analysis
was performed using logistic regression test
(SPSS 20.0 software).
Muscle mass
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 Surabaya Physical Medicine and Rehabilitation Journal. February 2020. Vol: 2. Ed: 1.
Muscle mass was a physical
measurement of muscle using Bioimpedance
Analysis (BIA) which is a device to measure fat
volume and muscle mass without fat. Muscle
mass is obtained from calculations of
Appendicular Skeletal Mass (ASM) divided by
the square of the height of the subjects
(kg/m2).8 This study uses a cut-off value of
muscle mass according to the AWGS
recommendations adjusted to the measurements
of 20 healthy young adult samples calculated
with a value of -2SD obtained for men < 6.1
kg/m2 and women <3.0 kg/m2.
European Working Group on
Sarcopenia in Older People (EWGSOP)
recommended Dual-energy X-ray
Absorptiometry (DXA), Computed
Tomography (CT), Magnetic Resonance
Imaging (MRI) and Bioimpedance Analysis
(BIA) to assess sarcopenia. Recently the
accuracy of DXA, CT and MRI is well known. 7
Accuracy of BIA in diagnosing sarcopenia has
been validated, but is very dependent to the
accuracy of the equipment equations and the
assessment conditions, e.g. temperature,
humidity, skin conditions, etc. However, due to
high cost and a high exposure of radiation from
Computed Tomography (CT), and due to
inconvenience of screening, CT and Magnetic
Resonance Imaging (MRI) have limited
application despite being the gold standard of
whole-body composition evaluation. On the
other hand, Dual-energy X-ray Absorptiometry
(DXA) is also thought to be an appropriate
alternative approach to distinguish between fat,
bone mineral and tissue.12
Now, DXA is probably the most used
device in measuring muscle mass in studies
about sarcopenia. DXA has minimal radiation
exposure but using DXA in community
screening is still challenging. A BIA tool model
was developed than; which has superiority to
obtain appendicular muscle mass measurements
with precise results. BIA tool is easy to carry,
affordable cost, faster processing, non-invasive,
radiation-free, and is convenient to use,
therefore is the right tool to measure sarcopenia
in the community. The results of fat-free mass
estimation of several segments using BIA are
strongly related to using DXA among the
elderly in Taiwan.9
A study in Asia stated that BIA tool is the
most used tool to measure sarcopenia and the
measurement results of BIA is consistent. BIA
tool is easy to carry and affordable, therefore
BIA is considered to be the main approach to
screen sarcopenia in the community. Therefore
the Asian Working Group for Sarcopenia
(AWGS) supports the use of BIA to diagnose
sarcopenia and evaluate the effects of
intervention program, however AWGS
recommended to provide variance coefficients,
also inter and intra-examiner reliability
evaluation to facilitate international
1
comparisons in the future.
Muscle strength
Muscle strength was defined as the
maximum strength of muscle to hold a load.
Thehandgrip muscle strength was measured
using hand dynamometer Takei Physical
Fitness Test and expressed on a number scale
indicated by the peak hold needle in kilograms
(kg) so that there was no bias in the
measurement. The procedure was the
following: before measurement, make sure the
subject’s hands were dry; the subject stands
relaxedwith their arms straightened down while
holding the instrument with their dominant
hand. Next, subject was instructed to pull the
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handgrip handle with all strength, avoid the arm
touching the body, and no swinging or
pumping. Measurementswere done three times
on the dominant hand, with 30-second rest, and
the highest value was taken as the handgrip
strength. Weak handgrip strength according to
AWGS is <26 kg for men and <18 kg for
women.13
EWGSOP recommends several ways to
measure muscle strength including: handgrip
strength, knee flexion/extension and peak
expiration. AWGS recommends using the
handgrip strength to measure muscle strength in
either research or clinical practice. The
handgrip strength has been widely used in
Asia.8
Physical performance
Physical performance was defined as a
form of mobility which is a part of physical
function.14 Short Physical Performance Battery
(SPPB) is a physical performance test to
evaluate balance, walking speed, strength, and
endurance by assessing individual’s ability to
stand in side-by-side feet position, semi-tandem
and tandem position, time to walk 8 feet and
time to stand from a chair and back to sitting 5
times.SPPB score is the sum of scores on three
tests: balance, gait speed, and chair stand. Each
test is given the same weight as a score,
between 0 and 4. The maximum score on the
SPPB is 12. SPPB 0–6 meansthe physical
performance is low, SPPB 7–9 means the
physical performance is moderate and SPPB
10–12 means physical performance is high. 7
Mobilization Limitations
Mobilization limitations were defined as
study subjects who clinically have difficulties
in the form of severe impairment with Barthel
index of (ADL ≤ 8) and/or having difficulties in
walking independently with/without aid,
arthritis or recent fracture.15This was meant to
be the exclusion criteria in this study.
Difficulties in Understanding the Instructions
Difficulties in understanding the
instructions were defined as study subjects with
difficulties in understanding examination
instructions since clinically they had
intellectual disturbances and/or severe cognitive
impairment with MMSE score < 18.15 This was
meant to be the exclusion criteria in this study.
Unable to Participate in Examinations
Unable to participate in examinations
were defined as study subjects with inability to
participate in examinations due to clinical
complications such as severe cardiovascular
diseases (NYHA class III and IV and high
respiratory rate that is more than 20 times per
minute (tachypnea).16This study was the
exclusion criteria.
Comorbidities
Comorbidities were defined as clinical
conditions or diseases that can cause,
complicated, or coincidence in the beginning or
in the clinical course of the subjects. In this
study the comorbidities were based on
Cumulative Illness Rating Scale (CIRS).
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Nutritional Status using MNA Score
MNA score or short for Mini Nutritional
Assessment is a method used to determine the
subjects’ nutritional status whether they were
normal, at risk for malnutrition, or
malnourished.
Barthel Activity Daily Living (ADL)
Barthel Activity Daily Living (ADL) is
used to determine daily living activity
capability such as walking, eating, putting on
clothes, taking a bath, cleaning themselves,
moving from lying down to sitting, controlling
the urge to urinate and defecate, and using the
toilet. This study excluded ADL ≤8 which
means severe and total dependence.
Mini Mental State Examination (MMSE)
Mini Mental State Examination
(MMSE) is a method used to determine the
cognitive functions. MMSE score ranged from
0 to 30.The exclusion criteria in this study was
MMSE score < 18.
Physical Activity Scale Of The Elderly (PASE)
Physical Activity Scale Of The Elderly
(PASE)is used to determine Daily Physical
Activity such as walking outside house, light
exercises (elderly gymnastic), moderate
exercises (fishing, fast walking, double-tennis),
strenuous exercises (single sport, moderate-fast
pace aerobic exercise, swimming, muscle
strength (weightlifting, push up, light
housework (washing the dishes), strenuous
housework (mopping), painting the wall/wiping
windows, cleaning the garden, outdoor
gardening, taking care of other people, and
working status.
Result
The subjects of this study were 203
elderly mainly consist of women as much as
146 (71.9%) and the rest were men as much as
57 (28.1%). The mean of the age was 64 years
old with the age ranging from 60 to 86 years
old. Most of the subjects that consist of 118
(58.1%) people were not working. The
adequacy of living costs/sufficient economy
status was found in 156 subjects (76.8%). There
were 136 (67%) subjects routinely exercised
and 193 (95.1%) subjects did not have a history
of consuming vitamin D. The profile of the
subjects acquired were 144 (70.9%)
independent subjects, 161 (79.3%) subjects had
no cognitive impairment, 144 (70.9%) were not
malnourished, 76 (37.4%) had normal BMI,
116 (57.1%) had low physical activity. The
main comorbidity based on Cumulative Illness
Rating Scale (CIRS) was musculoskeletal
condition on 137 (67.5%) subjects.
The subjects mainly had poor muscle
mass 122 (59.1%), mainly had strong muscle
strength (handgrip strength) 122 (60.1%) and
moderate physical performance of Short
Physical Performance Battery (SPPB) 90
(44.3%).
There was no correlation between
muscle mass and physical performance (SPPB)
with p=0.52. However, there was a correlation
between muscle strength (handgrip strength)
and physical performance (SPPB) with
correlation value of r = 0.26 (p<0.001) that
showed positive correlation with weak
correlation. The table showed that although the
muscle mass was poor the physical
performance (SPPB) was still good.
Figure 1 showed that there was positive
correlation between muscle strength (handgrip
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 Surabaya Physical Medicine and Rehabilitation Journal. February 2020. Vol: 2. Ed: 1.
strength) and physical performance (SPPB).
The stronger the muscle strength (handgrip
strength) was, the higher the physical
performance (SPPB) will be. This was in
accordance with the theory which states that
increased muscle strength will increase physical
performance (SPPB) which consists of balance
test, walking pace, and sit to stand test so that
this result was consistent with the previous
study which states that there is correlation
between muscle strength and physical
performance (SPPB).
12
10
8
SPPB
4
2 PASE and musculoskeletal comorbidities. Mini
0
0 10 20 30
HANDGRIP STRENGTH
40 50
Figure I. The representation of muscle strength
(handgrip strength) with physical performance
(SPPB)
This study showed that there was no
correlation between muscle mass and physical
performance (SPPB) with p value of 0.517 and
the correlation between muscle strength
(handgrip strength) and physical performance
(SPPB) with p value of 0.001 so that the
statistical analysis of this study will not be
continued to multivariate logistic regression
analysis.
Discussion
This study had a quite big difference in
the amount of women and men enrolled, with
women being the most of them. This is in
accordance with the data from Central Bureau
of Statistics East Java which stated that there
was an increased in the number of elderly
population up to year 2017 the number reached
236.541 (8.23% from total population), 51.59%
were women and 48.1% were men.17 A study in
Italy suggested that serum vitamin D level has
significant correlation with SPPB and muscle
strength (handgrip strength) both in men and
women. In this study most subjects did not
consume vitamin D and suffer from most
musculoskeletal comorbidities so that it affects
the subjects’ physical performance. The
subjects of the study were mostly independent;
this will indirectly affect the physical
performance of the subjects. Moderate level of
SPPB was mostly obtained in accordance with
the result of the study which showed that most
of the subjects were independent but had low
Mental State Examination(MMSE) score of the
subjects were mostly normal and not depressed
according to normal Geriatric Depression Scale
(GDS) score. A study in America showed a
significant correlation between muscle strength
(handgrip strength) and MMSE score with p
value of p < 0.001. A study in Japan suggested
that nutritional status indirectly influence
physical performance (SPPB) and ADL. Poor
nutritional status accompanied by comorbid
diseases will decrease insulin-like growth factor
production causing a decrease in muscle
strength and physical performance.18A study
that was conducted in America suggested that
there is significant correlation between BMI
and skeletal muscle mass both in men and
women. This is consistent with the result of this
study that subjects with normal MNA had
strong muscle strength (handgrip strength),
independent ADL and moderate SPPB. Low
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 Surabaya Physical Medicine and Rehabilitation Journal. February 2020. Vol: 2. Ed: 1.
Daily Physical Activity was linked with low
quality of life in elderly community. A study
that was conducted in Austria showed that
PASE had significant correlation with balance
skills, gait speed, and chair stands that were
part of Short Physical Performance Battery
(SPPB).19 A study in America also showed that
physical activity had significant correlation
with SBB.20 The subjects of the study were
mainly consist of low Physical Activity Scale
of the Elderly (PASE) and not working, but had
moderate SPPB, this is perhaps caused by
certain factors such as independent ADL,
normal MNA and normal MMSE.
Metabolic changes in aging process
consist of decreased muscle protein synthesis,
increased insulin resistance, and increased body
fat mass. The decreased basal metabolic cause
the muscle mass to decrease.5,21 Some studies
showed that age, sex, ethnicity, body weight,
BMI, protein intake, vitamin D level and
physical activity affect muscle mass. 1 A study
in America showed that there is significant
correlation between BMI and skeletal muscle
mass 47.9 %, with p < 0.05 in women and 50.1
% with p < 0,05 in men.
Other factors contributing to muscle
mass decrease are decreased alpha motor
neuron, low steroid hormone levels, low protein
intake and decreased physical activity. In
accordance with the previous study, in this
study we also concluded that low muscle mass
is related to age, sex and low physical activity.
A cross sectional study that was conducted in
Portuguese that measured muscle strength
(handgrip strength) in elderly population ≥65
years old, showed that men had strong muscle
strength (handgrip strength) compared to
women with p value < 0.001.22 A study in Asia
showed that muscle strength (handgrip
strength) will decrease along with increasing
age in all ethnicity and sex with p < 0.001.23
Age-related muscle strength reduction is caused
by decreased contractile protein (reduction of
muscle fiber caused by muscle and/or nerve
alteration), decreased muscle ability to change
muscle fibers length and the ability of central
nervous system to activate normal motor
neuron unit or a combination between those
mechanisms. Grimby and Saltin suggested that
decreased muscle strength in elderly occur
because of a reduction in the amount of muscle
fibers and not the quality. This theory was also
declared by Lexell et al. that decreased muscle
fibers in vastus lateralis muscle account for 40
% and the amount of muscle fibers was 39%
from 20 to 80 years old. The muscle fibers
decreased but the amount can still comply the
smallest muscle size needed. Poor nutritional
status accompanied by comorbid diseases will
decrease the insulin-like growth factor
production, causing a decrease in muscle
strength and physical performance.18 Consistent
with this study, strong muscle strength was
obtained with normal MNA and MMSE.
A study in Europe showed that muscle
strength (handgrip strength) of men and women
will decrease after 45 years of age and also a
decrease in chair stand test as a part of Short
Physical Performance Battery (SPPB) both in
men and women.24 This study was in
accordance with the previous study that showed
that moderate Short Physical Performance
Battery (SPPB) was obtained with strong
muscle strength (handgrip strength),
independent ADL and normal MNA. A
decrease in endocrine system function as a part
of aging process cause decreased Growth
Hormone (GH), Insulin-like growth factor-1
(IGF-1), estradiol, testosterone, and
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Dehydroepiandrosterone (DHEA) that are
needed for muscle fibers proliferation causing a
decrease in protein metabolism and finally a
decrease in muscle mass and eventually the
physical performance. However, there was no
correlation between muscle mass and physical
performance (SPPB) with p = 0.517. A study in
Asia also had similar result that showed no
correlation between muscle mass and physical
performance (SPPB) in elderly both in men and
women.4In this study it was possible that there
was a correlation between age and sex,
although there was poor muscle mass, the
physical performance (SPPB) was good
because the MNA and BMI were normal.
In this study there was a significant
correlation between muscle strength (handgrip
strength) and physical performance (SPPB)
with p = 0.001. A study in Asia showed that
low extremities muscle strength was
significantly correlated with physical
performance (SPPB), both in men (OR 0.950; p
= 0.012) and women (OR 0.107; p = 0.020).5 A
cohort prospective study carried out by Legrand
et al., 2013 in Belgium also suggested that there
was a correlation between muscle strength
(handgrip strength) and physical performance
determined by SPPB in elderly of the
community.6Studies in Canada and Brazil
analyzed SPPB as a screening test in frailty
subjects in the elderly community. The study
results showed the cut-off value of 9 in SPPB
had the best score which were sensitivity of
92% and specificity 80%. Bandinelli et al also
used cut-off value of 9 and showed the SPPB
scores affected the outcome of the study
subjects. The same results are also shown by
Verghese and Xue using cut-off value of 8 with
sensitivity was 52% and specificity was 70%,
and Vasunilashorn et al using cut-off value 10
with sensitivity 69% and specificity 84%. 25
In the aging process, pro-inflammatory
cytokines will increase the myosin protein and
reticulum sarcoplasm will decreasecausing a
decrease in type 2 muscle fibers affecting the
skeletal muscle contraction so that the muscle
strength and physical performance will
decrease. A cohort study done by Hughes et al.
in England showed that after being followed for
12 years, a decrease of the front thigh muscle
will significantly correlated with the diminished
knee extension ability in elderly men. Muscle
strength exercise program was a standard
rehabilitation technique to increase muscle
strength in elderly men. This exercise will
cause muscle hypertrophy due to an increase in
the size of type 1 and type 2 muscle fibers.
Muscle hypertrophy also causes an increase in
actomyosin protein. This mechanism can
become a part of increased muscle mass in
elderly people and some of muscle strength
enhancement caused by muscle hypertrophy. A
study in America showed a significant
correlation between muscle strength (handgrip
strength) and MMSE score with p < 0.01.
Consistent with the previous study, this study
also showed strong muscle strength with
moderate physical performance (SPPB) and
normal MNA and MMSE.
The limitations of this study is this
observational cross section study was done in
one time causing it unable to depict the subjects
clinical course, data and comorbidities were
obtained only through interviews and physical
examination and did not consider the
corresponding factors.
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 Surabaya Physical Medicine and Rehabilitation Journal. February 2020. Vol: 2. Ed: 1.
Conclusion
There is a positive correlation between
muscle strength (handgrip strength) and
physical performance (SPPB) with weak
correlation and there is no correlation between
muscle mass and physical performance (SPPB)
in elderly community in Surabaya. Muscle
strength (handgrip strength) plays a role in
physical performance (SPBB) in elderly
subjects.
Further studies are needed to understand
the correlation of muscle mass and muscle
strength (handgrip strength)with physical
performance in elderly community determined
using other physical performance test (usual
gait speed, get-up-and-go-test), and to
understand factors affecting the muscle mass,
muscle strength (handgrip strength) with
physical performance in elderly community
such as nutritional status (MNA/BMI),
endocrine system (GH, IGF-1), testosterone,
and DHEA), PASE, ADL and Vitamin D level
so that we can determine which factors play the
biggest role.
Acknowledgement
This study was supported by
Community health center in Surabaya and
Public health Office Surabaya.
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